Example:- Emergency GI Bleeds Explore Discovery Using Discovery to identify Benchmarked Activity for Specific Patient Groups (Diagnostic or Procedure) Example:- Emergency GI Bleeds

Methodology Requested a list of Diagnosis codes that would be used for ‘GI Bleed’ from the Health Board Coding department ICD 10 codes are the Diagnosis codes that are recorded for patient discharges from hospital K922 is the default ICD 10 code for ‘Gastrointestinal haemorrhage’, unspecified. K92 is the 3 Digit ICD 10 Code ‘Other Diseases of Digestive System’. However the coding department identified other codes that may be used. Please see appendix slide for these Went to:- Discovery ‘Consultant Team Dashboard’ and Procedure Diagnosis Search tab (Discovery Level 2) Average LOS Spells Dashboard: Diagnosis tab (Discovery Level 2) Average LOS Spells Dashboard: Data Tables tab (Discovery Level 3) At this Level Patient Chi information is available if user wants to pull case notes for further analysis

Consultant Team Dashboard (Discovery Level 2):-Procedure diagnosis search tab Click for Link to Consultant Team Dashboard 1. Clicked on the Diagnosis Radio button. Typed in K to the Search Diagnosis Box. This updates the Chapter and Code Drop down boxes so only data with a ‘K’ is shown. 2. Chose the K codes that the coding department identified as being relevant. The Information on Dashboard updated to show what ICD 10 Chapter, sub chapters are relevant for these codes 3. This Dashboard now shows activity for these specific diagnoses chosen and a monthly trend chart 4. It also shows the associated procedures for each diagnosis and the responsible consultant and Bed Days Please note:- information in the Consultant Team Dashboard is Episodic. A patient can have several episodes within a hospital stay. Episodes are created when a patient changes specialty, hospital, Significant facility or Consultant (for Medical Reasons). It is possible to export the information from Discovery that is presented in a table or a chart. To export data, select the chart or table containing the information you wish to export (by clicking on it), then click on the “Download” button (normally located near the top right of the dashboard) and choose the format you wish the data to be exported in.

Average LOS Spells Treatment:- Diagnosis Tab Click for Link to Average LOS (Spells) Treatment Dashboards 1. Selections made on the filters. 2. Then, using the chapter information from the last slide select on the Diagnosis chapter panel 3. Then select the Appropriate Sub Chapter. Users can multi-select Chapters and sub chapters as required This refines the information that is shown on the bottom table. The user can now see the spells associated with Non Elective Admissions with a Diagnosis that goes to 3 or 4 digit ICD 10 codes This dashboard is dynamic so selections made on one panel are reflected in the other panels. Holding down ctrl while you click on different areas of the graph will allow the user to multi-select Chapters/sub chapters. Based on this information the user can identify spell activity for the choices they have made. Specialty Spells have been calculated as an unbroken period of time that a patient spends within a specialty. A patient may change consultant or significant facility during a specialty spell. Tool tips appear with further information when the user hovers over different areas on the graph

Level 3 Average LOS Spells Treatment:-Data Tables tab Click to Link to Level 3 Average LOS Spells At Level 3 it is also possible to access Patient CHI information for patients with specific Diagnosis/procedures. 1. Appropriate choices made from the filter selectors. 2. Then click on the ‘Diagnosis’ radio button, chose required diagnosis’ from the drop down list. (Diagnosis are at 3 digits) 3. Table then renders for this selection. Blue numbers are hyperlinks and if clicked a CHI listing will appear for this selection which can be exported.

Other Useful Visualisations Consultant Team Dashboard:- Diagnosis 1. Appropriate choices made from the filter selectors. Note User can select Number or Days. 2. User can click on a Specific Diagnosis for the other panels in the chart to update. 3. Table then renders for this selection. Episodic activity information is available by consultant for episodes or BED DAYS with these diagnosis’. This table can be exported if required.

Discovery: Level 2: Hospital Spell Analysis: Hospital Tab (Note activity based on HB of Treatment) 1. Within the Hospital Spell Dashboard users can identified the high volume diagnosis for a specialty. Users can also filter on LOS Groups, to filter out long stays if required. 2. Hospital Summary Table compares hospitals within the health board for these diagnosis’. Scotland information also available. 3. LOS Distribution chart shows when patients are being discharged from Hospital. Useful to help investigate the scenario of Why is the variation in LOS between hospital s for the same diagnosis/procedure?

Summary Information Procedure/Diagnosis Information is based on the recorded Diagnosis Codes (ICD 10) and Procedure Codes (OPCS 4) for Hospital Activity. The procedure diagnosis search tab in the Consultant Team Dashboard will search for words from the actual diagnosis or procedure descriptions. User can identify procedures that have taken place for specific diagnosis, or vice versa diagnosis that have been linked to specific procedures. Consultant Team Dashboard information is available at an episodic level. Average LOS Spells are based on specialty spells which have been calculated as an unbroken period of time that a patient spends within a specialty. A patient may change consultant or significant facility during a specialty spell Hospital Spell Analysis information is available at a Hospital Spell level and is based on HB of Treatment. Diagnosis and specialty is based on the discharging (last) episode of the hospital spell. Procedure information is the 1st main procedure recorded for that hospital spell. Hospital Spell information calculated as an unbroken period of time that a patient spends within a hospital Data from Discovery can be extracted into excel format if required. Discovery can help benchmark activity and identify unwarranted variation.

Discovery Hints and Tips The A to Z page : highlights all the information available in Discovery and provides specific links to this information. Tool Tips: Throughout Discovery if the user hovers their cursor over any of the charts or data points a tool tip will appear with additional information Custom Views: Within each dashboard area it is possible to save specific visualisations (Custom Views) incorporating any filter selections the user has made. Pause button:- Clicking on the ‘Pause’ button allows users to make all of their filter selections at once rather than one at a time. Dynamic visualisations: Many of the dashboards in NSS Discovery are dynamic. This means that if you click on one area of a chart/table it will update the other areas/panels to reflect this choice. Exporting data from Discovery: To export data, select the chart or table containing the information you wish to export (by clicking on it), then click on the button (normally located near the top right of the dashboard) and choose the format you wish the data to be exported in. Metadata: - detailed metadata is available via the head icon at the top right of all dashboards.

For Discovery support and more information on accessing and using NSS Discovery, email us at:  nss.discovery@nhs.net or visit our website: www.nssdiscovery.scot.nhs.uk

Appendix ICD 10 Codes for ‘GI Bleed as advised by Coding department The default code for 'GI bleed' is K92.2 - Gastrointestinal haemorrhage, unspecified. Other GI codes with 'bleeding' K25 - Gastric ulcer K26 - Duodenal ulcer K27 - Peptic ulcer, site unspecified K28 - Gastrojejunal ulcer All of the ulcer with only the following 4th characters: .0 Acute with haemorrhage .2 - Acute with both perforation and haemorrhage .4 - Chronic or unspecified with haemorrhage .6 - Chronic or unspecified with perforation and haemorrhage K29.0 - Acute haemorrhagic gastritis Other Codes which may or may not be relevant for the search:- K22.6 - Gastro-oesophageal laceration-haemorrhage syndrome K22.8 - Other specified diseases of oesophagus. Please note that there are other conditions included in here - not just bleeding